What are the initial steps in the assessment of spasticity?

Updated: Mar 01, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Assessment of spasticity includes identifying which muscles or muscle groups are overactive and determining the effect of spasticity on all aspects of patient function, including mobility, employment, and activities of daily living (ADLs). Physical and occupational therapists are vital members of the team called in to assess and treat the patient with spasticity.

Identification of spastic muscles can be a complex task, since many muscles may cross the joint involved, and not all muscles with the potential to cause deformity will be spastic. Electromyography and diagnostic blocks with local anesthetics can be used to test hypotheses regarding the deformity and provide information for long-term denervation treatments.

Studies have been made of assessment tools, such as the Lateral Step Up test for adolescents with cerebral palsy and the Modified Ashworth Scale for the assessment of upper-limb muscles. [14, 15]

In an infant, spasticity is generally manifested by increased muscle tone. Abnormalities of muscle tone are most readily documented by assessing tone of supination and pronation of the upper extremities and dorsiflexion and plantar flexion of the lower extremities. In newborns or small infants, spasticity of the lower extremities becomes evident when the examiner suspends the infant by the feet, upside down, and each lower extremity is released in turn. In spasticity, the released lower extremity remains “hung up.”

Spasticity can wax and wane, appearing at variable times relative to the date of injury or disease onset. Involved muscles may demonstrate spontaneous or elicited clonus, as well as increased deep tendon reflexes.

Spasticity can occur in any muscle, but common patterns exist, especially when associated with an upper motor neuron injury. Understanding these patterns helps to predict a patient’s future functional status, as well as cosmetic or orthopedic deformities that may occur, aiding in treatment decisions.


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